NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE PUBLIC HEALTH INTERVENTION GUIDANCE 1 Guidance title SCOPE Interventions delivered in primary and secondary schools to prevent and/or reduce alcohol use by young people under 18 years old 1.1. Short title School-based interventions on alcohol 2 Background a) The National Institute for Health and Clinical Excellence ( NICE or the Institute ) has been asked by the Department of Health (DH) to develop guidance on public health interventions in primary and secondary schools aimed at preventing and/or reducing alcohol use among young people. b) NICE public health intervention guidance supports implementation of the preventive aspects of national service frameworks (NSFs) where a framework has been published. The statements in each NSF reflect the evidence that was used at the time the framework was prepared. The public health guidance published by the Institute after an NSF has been issued will have the effect of updating the framework. Specifically, in this case, the guidance will support the following NSFs and other government policy documents: Alcohol harm reduction strategy for England (Prime Minister s Strategy Unit 2004) Drugs: guidance for schools (DfES 2004a) Healthy living blueprint for schools (DfES 2004b) Page 1 of 10
National healthy school status a guide for schools (DfES and DH 2005) Updated drugs strategy 2002 (Home Office 2002) The national service framework for children, young people and maternity services. Core standards (DH 2004a) Every child matters and Every child matters: Change for children programme (HM Government 2003, 2004) (including the Change for children in schools 2004 and Young people and drugs 2005 elements) Choosing health making healthy choices easier (DH 2004b). c) This guidance will provide recommendations for good practice, based on the best available evidence of effectiveness, including cost effectiveness. It is aimed at teachers, school governors and professionals with public health as part of their remit working within the NHS, local authorities and the wider public, private, voluntary and community sectors. 3 The need for guidance a) Alcohol use among young people is growing faster than the use of any other drug in the UK and it causes the most widespread problems among them. It is also the least regulated and most heavily marketed (Advisory Council on the Misuse of Drugs 2006). b) In 2005, around 22% of 11 15 year olds in England had drunk alcohol in the previous week. They consumed an average 10.5 units an increase from 5.3 units in 1990. Prevalence of drinking increased with age. Three per cent of pupils age 11 and 46% of 15 year olds had drunk alcohol in the previous week (NHS Health and Social Care Information Centre 2006a). c) Regular heavy alcohol consumption and binge drinking are associated with physical problems, antisocial behaviour, violence, accidents, suicide, injuries and road traffic accidents. School performance and crime can also be affected (BMA 2006). d) Truancy and exclusion from school are associated with an increased likelihood of underage drinking. In 2005, over 50% of recent truants aged Page 2 of 10
11 to 15 reported drinking alcohol in the previous week. This compares to around 17% who had never truanted (Fuller 2006). e) Young people report having more risky sex when they are under the influence of alcohol. They also say that alcohol is a main reason why they had sex, especially at an early age or with someone they had not known for very long (Alcohol Concern 2002). f) In 2000, nearly 14% of 16 to 19 years olds in Britain were either mildly (12.4%) or moderately (1.4%) dependent on alcohol (Singleton et al. 2002). In 2004 05, approximately 2500 children aged 0 14 years in England were admitted to hospital with a primary, alcohol-related diagnosis (NHS Health and Social Care Information Centre 2006b). 4 The guidance a) Public health guidance will be developed according to NICE processes and methods. For details see section 5. b) This document is the scope. It defines exactly what this guidance will (and will not) examine, and what the guidance developers will consider. The scope is based on a referral from the DH (see appendix A). 4.1 Populations 4.1.1 Groups that will be covered Children and young people under 18 years old in educational institutions including, but not limited to: state sector primary and secondary schools city technology colleges, academies, pupil referral units, secure training and local authority secure units, grammar schools, special and independent primary and secondary schools further education colleges. Page 3 of 10
4.2 Groups that will not be covered Children and young people who do not attend any of the educational institutions listed above, including those in secure institutions and those receiving home education. 4.3 Areas 4.3.1 Areas that will be covered Interventions in primary and secondary schools that aim to prevent or reduce alcohol use. These include, but are not limited to: lessons delivered by teachers or other professionals as part of personal, social and health education (PSHE), or as part of the National Curriculum peer led education by other pupils interventions delivered by external agencies and individuals (including, but not limited to, contributions from the police, theatre in education (TIE) providers and life education centres) school policies the informal curriculum. This could include pastoral care and other extracurricula activities such as parent evenings and school trips. 4.3.2 Areas that will not be covered a) Interventions delivered in the community, including server and responsible beverage service (RBS) training, media campaigns and diversionary activities. b) Regulatory schemes including alcohol taxation, restrictions on alcohol sales and advertising, proof of age schemes and alcohol warning labels. c) Drink-driving schemes and driver training. d) Treatment of alcohol misuse or alcohol dependence, including psychosocial interventions. Page 4 of 10
4.4 Comparators The interventions will be examined, where possible, against no intervention and against each other. 4.5 Outcomes 4.5.1 Primary outcomes Changes in alcohol consumption among children and young people including: the percentage who drink the volume they drink and how frequently the age when they first drink alcohol unsupervised use. 4.5.2 Secondary outcomes The following secondary outcomes will be assessed where a study reports a primary outcome: attitudes towards and knowledge about alcohol interpersonal skills, including the ability to refuse alcohol alcohol-related absence from school and poor school attainment alcohol-related violence and crime (including arrests for drink driving), prosecutions, incarcerations and anti-social behaviour illegal sales of alcohol alcohol-related morbidity including hospitalisation alcohol-related mortality. Page 5 of 10
4.6 Key questions The following key question will be addressed: What are the most effective and cost-effective school-based interventions to prevent or reduce alcohol use among under 18 year olds? Subsidiary questions may include: What type of content works best? (For example, should it focus on the harmful effects to health, legal issues or the social consequences of alcohol use?) Is it better for the intervention to be delivered by a generalist, a specialist, or someone else (for example, the police, a peer or a drug worker)? What are the most cost effective and appropriate interventions for different groups of young people (for example, males and females, different age groups, different social classes and different ethnic groups)? Does the intervention lead to any adverse or unintended effects (for example, an increase in alcohol consumption)? What factors might inhibit or facilitate implementation (for example, parents views)? 4.7 Target audiences and settings for the guidance The guidance will be aimed at teachers, school governors and others (including school nurses and healthy school leads) who work in or with primary and secondary schools and further education colleges. It will also be aimed at all those who train teachers and relevant professionals in local authorities (including directors of children s services and DAATs, and leads on crime disorder reduction partnerships (CDRPs) and local area agreements (LAAs)). Page 6 of 10
4.8 Status of this document This is the final scope, incorporating comments from a 4 week consultation which included a stakeholder meeting on Wednesday 11 October 2006. 5 Further information The public health guidance development process and methods are described in Methods for development of NICE public health guidance (NICE 2006) and The public health guidance development process: an overview for stakeholders, including public health practitioners, policy makers and the public (NICE 2006) available at: www.nice.org.uk/page.aspx?o=300576 6 NICE related guidance Under development Interventions (including screening) to reduce the transmission of chlamydia and other sexually transmitted infections (STIs) and to reduce the rate of under eighteen conceptions, especially among vulnerable and at risk groups (due February 2007). Community-based interventions to reduce substance misuse among the most vulnerable and disadvantaged young people (due March 2007). The most appropriate generic and specific interventions to support attitude and behaviour change at population and community levels (due October 2007). Page 7 of 10
Appendix A Referral from the Department of Health The Department of Health asked the Institute to: produce guidance for use in primary and secondary schools on sensible alcohol consumption. Page 8 of 10
Appendix B References Advisory Council on the Misuse of Drugs (2006) Pathways to problems: hazardous use of tobacco, alcohol and other drugs by young people in the UK and its implications for policy. London: Advisory Council on the Misuse of Drugs. Alcohol Concern (2002) Alcohol and teenage pregnancy. London: Alcohol Concern. British Medical Association Alcohol young people [online]. Available from: www.bma.org.uk/ap.nsf/content/alcoholyoungpeople [accessed 4 April 2006]. Department for Education and Skills (2004a) Drugs: guidance for schools. London: Department for Education and Skills. Department for Education and Skills (2004b) Healthy living blueprint for schools. London: Department for Education and Skills. Department for Education and Skills and Department of Health (2005) National healthy school status a guide for schools. London: Department of Health. Department of Health (2004a) National service framework for children, young people and maternity services. Core standards. London: Department of Health. Department of Health (2004b) Choosing health: making healthier choices easier. London: Department of Health. Fuller E editor (2006) Drug use, smoking and drinking among young people in England in 2005. Leeds: NHS Health and Social Care Information Centre. HM Government (2003) Every child matters. London: The Stationery Office. HM Government (2004) Every child matters: change for children. London: Department for Education and Skills. Page 9 of 10
Home Office (2002) Updated drug strategy 2002. London: Home Office. NHS Health and Social Care Information Centre (2006a) Drug use, smoking and drinking among young people in England in 2005 headline figures. Leeds: NHS Health and Social Care Information Centre. NHS Health and Social Care Information Centre (2006b) Hospital episode statistics [online]. Available from: www.hesonline.nhs.uk [accessed 6 September 2006]. Prime Minister s Strategy Unit (2004) Alcohol harm reduction strategy for England. London: Strategy Unit. Singleton N, Bumptstead R, O Brien M et al. (2002) Psychiatric morbidity among adults living in England in 2001. London: The Stationery Office. Page 10 of 10